Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
Eur J Heart Fail. 2013 Jan;15(1):103-9. doi: 10.1093/eurjhf/hfs133. Epub 2012 Aug 23.
Heart failure (HF) is a chronic condition that typically affects a patient's quality of life (QoL). Little is known about long-term QoL monitoring in HF. This study aimed to evaluate the temporal changes and prognostic value of QoL assessment in a real-life cohort of HF patients.
The Minnesota Living with Heart Failure Questionnaire was used to monitor QoL at baseline and at 1, 3, and 5 years for 1151 consecutive patients {71.7% men, median age 69 years [25th-75th percentiles (P(25)-P(75)) 59-76]} in an HF unit. Follow-up for prognosis assessment was extended to 6 years. The number of answered questionnaires was 1151 at baseline, 746 at 1 year, 268 at 3 years, and 240 at 5 years. QoL scores showed a steep decrease (indicating QoL improvement) during the first year [29 (P(25)-P(75) 16-43) at baseline vs. 15 (P(25)-P(75) 8-27) at 1 year, P < 0.001], which was tempered, yet significant up to 5 years [12 (P(25)-P(75) 7-23) at 3 years vs. 10 (P(25)-P(75) 5-21) at 5 years, P = 0.012]. We recorded 457 deaths during follow-up. In a comprehensive multivariable Cox regression analysis, baseline QoL remained a significant prognosticator during follow-up [hazard ratio (HR)(Cox) for death 1.012, 95% confidence interval 1.006-1.018, P < 0.001]. QoL monitoring showed that a score increase ≥10% between consecutive assessments stratified high-risk patients within the next 12 months (P = 0.008).
Both baseline and follow-up QoL monitoring were useful for patient risk stratification in a real-life HF cohort. Worse QoL may warn of a worse prognosis. Widespread QoL monitoring in routine clinical practice is recommended.
心力衰竭（HF）是一种慢性疾病，通常会影响患者的生活质量（QoL）。对于 HF 患者的长期 QoL 监测，人们知之甚少。本研究旨在评估真实 HF 患者队列中 QoL 评估的时间变化和预后价值。
使用明尼苏达州心力衰竭生活质量问卷（Minnesota Living with Heart Failure Questionnaire）在基线以及 1、3 和 5 年时评估 1151 例连续患者（71.7%为男性，中位年龄 69 岁[25%至 75%分位数（P25-P75）为 59-76]）的 QoL。对预后评估的随访延长至 6 年。基线时回答问卷的数量为 1151 份，1 年时为 746 份，3 年时为 268 份，5 年时为 240 份。QoL 评分在第一年急剧下降（表明 QoL 改善）[基线时为 29（P25-P75 为 16-43），1 年时为 15（P25-P75 为 8-27），P <0.001]，直至 5 年时仍保持显著下降[3 年时为 12（P25-P75 为 7-23），5 年时为 10（P25-P75 为 5-21），P = 0.012]。随访期间共记录到 457 例死亡。在综合多变量 Cox 回归分析中，基线 QoL 在随访期间仍然是一个显著的预后预测因素[死亡的风险比（HR）（Cox）为 1.012，95%置信区间为 1.006-1.018，P <0.001]。QoL 监测显示，在接下来的 12 个月内，连续评估时评分增加≥10%可对高风险患者进行分层（P = 0.008）。
在真实的 HF 队列中，基线和随访 QoL 监测均有助于患者风险分层。较差的 QoL 可能预示着预后较差。建议在常规临床实践中广泛进行 QoL 监测。
